Privacy Policy

Dear Valued Patient,

This notice describes our attached privacy policy for how medical information which you authorize may be used and disclosed, how you can get access to this information, and how your privacy is being protected. In order to maintain the level of service that you expect from our office, we may need to share limited personal medical and financial information with your insurance company¸ with Worker’s Compensation (and your employer as well in this instance), or with other medical practitioners that you authorize.

Safeguards in place at our office include:

Controlled access to facilities where information is stored.

Policies and procedures for handling information.

Requirements for third parties to contractually comply with privacy laws.

All medical files and records (including email, regular mail, telephone, and faxes sent) are kept on permanent file.

We value our relationship, and respect your right to privacy. If you have questions about our privacy guidelines, please call us during regular business hours at 1-520-780-1230.

Yours truly,

Jill Darban. L.Ac., Dipl. O.M.

Desert Sands Acupuncture Clinic

698 E. Wetmore Road, Suite 420

Tucson, Arizona 85705

Privacy Policy Notice

This Notice is required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Effective April, 14, 2003

Your Personal and Protected Health Information (PHI)

We may gather personal and health information from you, other health care providers and third party players. This information is used for treatment, payment and health care operations. The following describes the ways we may use and disclose your Protected Health information:

· We may provide Protected Health Information about you to health care providers, other practice personnel, or third parties who are involved in the provision, management or coordination of your treatment care.

· We may disclose your PHI to any third party you designate in writing.

· We may use or disclose your PHI so that we can collect or make payment for the health care services you receive or are going to receive.

· We may disclose your PHI if we ever sell or transfer our practice.

· We may disclose your PHI if we believe it is necessary to prevent a serious threat to your health and safety or the health and safety of the public.

· We may disclose your PHI to a government agency if we believe you have been a victim of abuse, neglect or domestic violence. We will make this disclosure if it is necessary to prevent serious harm to you or other potential victims, you are unable to agree due to your incapacity, you agree to the disclosure, or required by law.

· We may disclose your PHI to a health oversight agency for activities authorized by law.

· We may disclose your PHI as required by a court or administrative order, or under certain circumstances in response to a subpoena, discovery request or other legal process

· We may release your PHI as necessary to comply with laws relating to Workers’ Compensation or similar programs that are established by the law to provide benefits for work-related injuries or illness without regard to fault.

· We may disclose your PHI as to a HIPAA certified Business Associate (a person or organization that

· performs a function or activity on behalf of the practice that involves the use or disclosure of PHI, such as billing services company or another practitioner who is involved in your health care.

· Your PHI may be disclosed for military and veterans affairs, for national security and intelligence activities, or for correctional activities.

· We may use or disclose your PHI when required by law.

· We may use your name, address, phone number, e-mail, and your records to contact you with appointment reminder calls, recall postcards, greeting cards, information about alternative therapies, or other related

· information that may be of interest to you. If you are not at home to receive an appointment reminder, a message may be left on your answering machine.

Please note your rights regarding this information:

· You are entitled to inspect and receive copies of your records.

· You are entitled to make a written request to amend your PHI files or put restrictions on certain uses and disclosure of PHI.

· We accommodate any reasonable request, yet we retain the right to deny inclusion of amendments or use restrictions of your PHI.

· You have the right to disagree with the practitioner’s refusal of inclusion.

· You have a right to receive all notices in writing.

· You have the right that we do not disclose your information to specific individuals, companies, or organizations. Any restrictions should be requested in writing. We are not required to honor these requests. If we agree with your restrictions, the restriction is binding to us.

· You may complain to us or the Secretary for Health and Human Services if you feel that we have violated your privacy rights. There will be no retaliation for filing a complaint. Written comments should be addressed to our Privacy Officer at our office address or the secretary for Health and human services, 200 Independence Ave. SW, Room 509F, HHH Bldg. Washington, DC 20201.